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Cai D, Wang X, Hu W, Mo J, Liu H, Li X, Zheng X, Ding X, An J, Hua Y, Zhang J, Zhang K, Zhang C. The 3-Dimensional Intelligent Structured Light Technique: A New Registration Method in Stereotactic Neurosurgery. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01145. [PMID: 38687040 DOI: 10.1227/ons.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surface-based facial scanning registration emerged as an essential registration method in the robot-assisted neuronavigation surgery, providing a marker-free way to align a patient's facial surface with the imaging data. The 3-dimensional (3D) structured light was developed as an advanced registration method based on surface-based facial scanning registration. We aspire to introduce the 3D structured light as a new registration method in the procedure of the robot-assisted neurosurgery and assess the accuracy, efficiency, and safety of this method by analyzing the relative operative results. METHODS We analyzed the results of 47 patients who underwent Ommaya reservoir implantation (n = 17) and stereotactic biopsy (n = 30) assisted by 3D structured light at our hospital from January 2022 to May 2023. The accuracy and additional operative results were analyzed. RESULTS For the Ommaya reservoir implantation, the target point error was 3.2 ± 2.2 mm and the entry point error was 3.3 ± 2.4 mm, while the operation duration was 35.8 ± 8.3 minutes. For the stereotactic biopsy, the target point error was 2.3 ± 1.3 mm and the entry point error was 2.7 ± 1.2 mm, while the operation duration was 24.5 ± 6.3 minutes. CONCLUSION The 3D structured light technique reduces the patients' discomfort and offers the advantage of a simpler procedure, which can improve the clinical efficiency with the sufficient accuracy and safety to meet the clinical requirements of the puncture and navigation.
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Affiliation(s)
- Du Cai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhan Hu
- Department of Neuroelectrophysiology, Beijing Neurosurgical Institute, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huanguang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoyan Li
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xixi Zheng
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaosheng Ding
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juan An
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichun Hua
- Department of Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Li C, Fan X, Aronson JP, Hong J, Khan T, Paulsen KD. Model-based image updating in deep brain stimulation with assimilation of deep brain sparse data. Med Phys 2023; 50:7904-7920. [PMID: 37418478 DOI: 10.1002/mp.16578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Accuracy of electrode placement for deep brain stimulation (DBS) is critical to achieving desired surgical outcomes and impacts the efficacy of treating neurodegenerative diseases. Intraoperative brain shift degrades the accuracy of surgical navigation based on preoperative images. PURPOSE We extended a model-based image updating scheme to address intraoperative brain shift in DBS surgery and improved its accuracy in deep brain. METHODS We evaluated 10 patients, retrospectively, who underwent bilateral DBS surgery and classified them into groups of large and small deformation based on a 2 mm subsurface movement threshold and brain shift index of 5%. In each case, sparse brain deformation data were used to estimate whole brain displacements and deform preoperative CT (preCT) to generate updated CT (uCT). Accuracy of uCT was assessed using target registration errors (TREs) at the Anterior Commissure (AC), Posterior Commissure (PC), and four calcification points in the sub-ventricular area by comparing their locations in uCT with their ground truth counterparts in postoperative CT (postCT). RESULTS In the large deformation group, TREs were reduced from 2.5 mm in preCT to 1.2 mm in uCT (53% compensation); in the small deformation group, errors were reduced from 1.25 to 0.74 mm (41%). Average reduction of TREs at AC, PC and pineal gland were significant, statistically (p ⩽ 0.01). CONCLUSIONS With more rigorous validation of model results, this study confirms the feasibility of improving the accuracy of model-based image updating in compensating for intraoperative brain shift during DBS procedures by assimilating deep brain sparse data.
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Affiliation(s)
- Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Joshua P Aronson
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jennifer Hong
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Tahsin Khan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
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Shimamoto T, Sano Y, Yoshimitsu K, Masamune K, Muragaki Y. Precise Brain-shift Prediction by New Combination of W-Net Deep Learning for Neurosurgical Navigation. Neurol Med Chir (Tokyo) 2023; 63:295-303. [PMID: 37164701 PMCID: PMC10406456 DOI: 10.2176/jns-nmc.2022-0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/01/2023] [Indexed: 05/12/2023] Open
Abstract
Brain tissue deformation during surgery significantly reduces the accuracy of image-guided neurosurgeries. We generated updated magnetic resonance images (uMR) in this study to compensate for brain shifts after dural opening using a convolutional neural network (CNN). This study included 248 consecutive patients who underwent craniotomy for initial intra-axial brain tumor removal and correspondingly underwent preoperative MR (pMR) and intraoperative MR (iMR) imaging. Deep learning using CNN to compensate for brain shift was performed using the pMR as input data, and iMR obtained after dural opening as the ground truth. For the tumor center (TC) and the maximum shift position (MSP), statistical analysis using the Wilcoxon signed-rank test was performed between the target registration error (TRE) for the pMR and iMR (i.e., the actual amount of brain shift) and the TRE for the uMR and iMR (i.e., residual error after compensation). The TRE at the TC decreased from 4.14 ± 2.31 mm to 2.31 ± 1.15 mm, and the TRE at the MSP decreased from 9.61 ± 3.16 mm to 3.71 ± 1.98 mm. The Wilcoxon signed-rank test of the pMR TRE and uMR TRE yielded a p-value less than 0.0001 for both the TC and MSP. Using a CNN model, we designed and implemented a new system that compensated for brain shifts after dural opening. Learning pMR and iMR with a CNN demonstrated the possibility of correcting the brain shift after dural opening.
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Affiliation(s)
- Takafumi Shimamoto
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
- FUJIFILM Healthcare Corporation
| | | | - Kitaro Yoshimitsu
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Ken Masamune
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
- Center for Advanced Medical Engineering Research and Development, Kobe University
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Song Y, Surgenor JV, Leeds ZT, Kanter JH, Martinez-Camblor P, Smith WJ, Boone MD, Abess AT, Evans LT, Kobylarz EJ. Variables associated with cortical motor mapping thresholds: A retrospective data review with a unique case of interlimb motor facilitation. Front Neurol 2023; 14:1150670. [PMID: 37114230 PMCID: PMC10128911 DOI: 10.3389/fneur.2023.1150670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Intraoperative neuromonitoring (IONM) is crucial to preserve eloquent neurological functions during brain tumor resections. We observed a rare interlimb cortical motor facilitation phenomenon in a patient with recurrent high-grade glioma undergoing craniotomy for tumor resection; the patient's upper arm motor evoked potentials (MEPs) increased in amplitude significantly (up to 44.52 times larger, p < 0.001) following stimulation of the ipsilateral posterior tibial nerve at 2.79 Hz. With the facilitation effect, the cortical MEP stimulation threshold was reduced by 6 mA to maintain appropriate continuous motor monitoring. It likely has the benefit of reducing the occurrence of stimulation-induced seizures and other adverse events associated with excessive stimulation. Methods We conducted a retrospective data review including 120 patients who underwent brain tumor resection with IONM at our center from 2018 to 2022. A broad range of variables collected pre-and intraoperatively were reviewed. The review aimed to determine: (1) whether we overlooked this facilitation phenomenon in the past, (2) whether this unique finding is related to any specific demographic information, clinical presentation, stimulation parameter (s) or anesthesia management, and (3) whether it is necessary to develop new techniques (such as facilitation methods) to reduce cortical stimulation intensity during intraoperative functional mapping. Results There is no evidence suggesting that clinical presentation, stimulation configuration, or intraoperative anesthesia management of the patient with the facilitation effect were significantly different from our general patient cohort. Even though we did not identify the same facilitation effect in any of these patients, we were able to determine that stimulation thresholds for motor mapping are significantly associated with the location of stimulation (p = 0.003) and the burst suppression ratio (BSR) (p < 0.001). Stimulation-induced seizures, although infrequent (4.05%), could occur unexpectedly even when the BSR was 70%. Discussion We postulated that functional reorganization and neuronal hyperexcitability induced by glioma progression and repeated surgeries were probable underlying mechanisms of the interlimb facilitation phenomenon. Our retrospective review also provided a practical guide to cortical motor mapping in brain tumor patients under general anesthesia. We also underscored the need for developing new techniques to reduce the stimulation intensity and, hence, seizure occurrence.
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Affiliation(s)
- Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- *Correspondence: Yinchen Song,
| | - James V. Surgenor
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Haverford College, Haverford, PA, United States
| | - Zachary T. Leeds
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - John H. Kanter
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - William J. Smith
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - M. Dustin Boone
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Alexander T. Abess
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Erik J. Kobylarz
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
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Pivazyan G, Sandhu FA, Beaufort AR, Cunningham BW. Basis for error in stereotactic and computer-assisted surgery in neurosurgical applications: literature review. Neurosurg Rev 2022; 46:20. [PMID: 36536143 DOI: 10.1007/s10143-022-01928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Technological advancements in optoelectronic motion capture systems have allowed for the development of high-precision computer-assisted surgery (CAS) used in cranial and spinal surgical procedures. Errors generated sequentially throughout the chain of components of CAS may have cumulative effect on the accuracy of implant and instrumentation placement - potentially affecting patient outcomes. Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of CAS. Error reporting measures vary between studies. Understanding error generation, mechanisms of propagation, and how they relate to workflow can assist clinicians in error mitigation and improve accuracy during navigation in neurosurgical procedures. Diligence in planning, fiducial positioning, system registration, and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final instrumentation and implant position. This study reviews the potential errors associated with each step in computer-assisted surgery and provides a basis for disparity in intrinsic accuracy versus achieved accuracy in the clinical operative environment.
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Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Bryan W Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Mulita F, Verras GI, Anagnostopoulos CN, Kotis K. A Smarter Health through the Internet of Surgical Things. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22124577. [PMID: 35746359 PMCID: PMC9231158 DOI: 10.3390/s22124577] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 05/14/2023]
Abstract
(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.
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Affiliation(s)
- Francesk Mulita
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Department of Surgery, General University Hospital of Patras, 26504 Rio, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
| | | | | | - Konstantinos Kotis
- Intelligent Systems Lab, Department of Cultural Technology and Communication, University of the Aegean, 81100 Mytilene, Greece;
- Correspondence: (F.M.); (K.K.); Tel.: +30-6974822712 (K.K.)
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Koike T, Kin T, Tanaka S, Sato K, Uchida T, Takeda Y, Uchikawa H, Kiyofuji S, Saito T, Takami H, Takayanagi S, Mukasa A, Oyama H, Saito N. Development of a New Image-Guided Neuronavigation System: Mixed-Reality Projection Mapping Is Accurate and Feasible. Oper Neurosurg (Hagerstown) 2021; 21:549-557. [PMID: 34634817 DOI: 10.1093/ons/opab353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Image-guided systems improve the safety, functional outcome, and overall survival of neurosurgery but require extensive equipment. OBJECTIVE To develop an image-guided surgery system that combines the brain surface photographic texture (BSP-T) captured during surgery with 3-dimensional computer graphics (3DCG) using projection mapping. METHODS Patients who underwent initial surgery with brain tumors were prospectively enrolled. The texture of the 3DCG (3DCG-T) was obtained from 3DCG under similar conditions as those when capturing the brain surface photographs. The position and orientation at the time of 3DCG-T acquisition were used as the reference. The correct position and orientation of the BSP-T were obtained by aligning the BSP-T with the 3DCG-T using normalized mutual information. The BSP-T was combined with and displayed on the 3DCG using projection mapping. This mixed-reality projection mapping (MRPM) was used prospectively in 15 patients (mean age 46.6 yr, 6 males). The difference between the centerlines of surface blood vessels on the BSP-T and 3DCG constituted the target registration error (TRE) and was measured in 16 fields of the craniotomy area. We also measured the time required for image processing. RESULTS The TRE was measured at 158 locations in the 15 patients, with an average of 1.19 ± 0.14 mm (mean ± standard error). The average image processing time was 16.58 min. CONCLUSION Our MRPM method does not require extensive equipment while presenting information of patients' anatomy together with medical images in the same coordinate system. It has the potential to improve patient safety.
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Affiliation(s)
- Tsukasa Koike
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Katsuya Sato
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Uchida
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Takeda
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Hiroki Uchikawa
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Toki Saito
- Department of Clinical Information Engineering, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | | | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
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Chekhonin IV, Batalov AI, Zakharova NE, Pogosbekyan EL, Nikitin PV, Bykanov AE, Pitskhelauri DI, Pronin IN. [Magnetic resonance relaxometry in high-grade glioma subregion assessment - neuroimaging and morphological correlates]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:41-48. [PMID: 34463449 DOI: 10.17116/neiro20218504141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the differences of high-grade glioma subregions using magnetic resonance relaxometry with compilation of images (MAGiC) and arterial spin labeling (ASL), as well as to compare quantitative measurements of these techniques with morphological data. MATERIAL AND METHODS The study enrolled 35 patients with newly diagnosed supratentorial gliomas (23 - grade IV, 12 - grade III). We measured relaxometric values (T1, T2, proton density), tumor blood flow (TBF) in glioma subregions and normal-appearing brain matter. Neuronavigation was intraoperatively used to obtain tissue samples from active tumor growth zone, perifocal infiltrative edema zone and adjacent brain matter along surgical approach. RESULTS ASL perfusion revealed higher tumor blood flow (TBF) in active tumor growth region compared to perifocal infiltrative edema zone (p<0.01). Relaxometric values (T1, T2, proton density) in perifocal zone were higher (p<0.01) compared to adjacent intact white matter along surgical approach. However, there were no differences in TBF between these zones. Proton density in tumor-adjacent intact white matter was higher (p<0.01) compared to normal-appearing white matter in ipsilateral hemisphere. There was inverse correlation between T2 and TBF in active tumor growth zone (Spearman rank R= -0.58; p=0.0016). We found inverse correlation between T2 and Ki67 proliferative index and direct correlation between TBF and Ki67 in this zone. Nevertheless, these relationships were insignificant after multiple test adjustment. CONCLUSION Our study advocates for complementary power of ASL perfusion and MR relaxometry in assessment of high-grade brain glioma subregions. More malignant tumor zones tend to have higher TBF and shorter T2. Further investigation is needed to prove the capability of MAGiC to reveal foci of increased relaxometric values in tumor-adjacent normal-appearing white matter.
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Affiliation(s)
| | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - P V Nikitin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A E Bykanov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Koike T, Kin T, Tanaka S, Takeda Y, Uchikawa H, Shiode T, Saito T, Takami H, Takayanagi S, Mukasa A, Oyama H, Saito N. Development of Innovative Neurosurgical Operation Support Method Using Mixed-Reality Computer Graphics. World Neurosurg X 2021; 11:100102. [PMID: 33898969 PMCID: PMC8059082 DOI: 10.1016/j.wnsx.2021.100102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background In neurosurgery, it is important to inspect the spatial correspondence between the preoperative medical image (virtual space), and the intraoperative findings (real space) to improve the safety of the surgery. Navigation systems and related modalities have been reported as methods for matching this correspondence. However, because of the influence of the brain shift accompanying craniotomy, registration accuracy is reduced. In the present study, to overcome these issues, we developed a spatially accurate registration method of medical fusion 3-dimensional computer graphics and the intraoperative brain surface photograph, and its registration accuracy was measured. Methods The subjects included 16 patients with glioma. Nonrigid registration using the landmarks and thin-plate spline methods was performed for the fusion 3-dimensional computer graphics and the intraoperative brain surface photograph, termed mixed-reality computer graphics. Regarding the registration accuracy measurement, the target registration error was measured by two neurosurgeons, with 10 points for each case at the midpoint of the landmarks. Results The number of target registration error measurement points was 160 in the 16 cases. The target registration error was 0.72 ± 0.04 mm. Aligning the intraoperative brain surface photograph and the fusion 3-dimensional computer graphics required ∼10 minutes on average. The average number of landmarks used for alignment was 24.6. Conclusions Mixed-reality computer graphics enabled highly precise spatial alignment between the real space and virtual space. Mixed-reality computer graphics have the potential to improve the safety of the surgery by allowing complementary observation of brain surface photographs and fusion 3-dimensional computer graphics.
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Key Words
- 2D, 2-Dimensional
- 3D, 3-Dimensional
- 3DCG, 3-Dimensional computer graphics
- AR, Augmented reality
- Brain shift
- CT, Computed tomography
- Computer graphics
- FOV, Field of view
- Glioma
- Landmark
- MRCG, Mixed-reality computer graphics
- MRI, Magnetic resonance imaging
- Mixed-reality
- TE, Echo time
- TR, Repetition time
- Target registration error
- Thin-plate spline
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Affiliation(s)
- Tsukasa Koike
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- To whom correspondence should be addressed: Taichi Kin, M.D.
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Takeda
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Uchikawa
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Shiode
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toki Saito
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunsaku Takayanagi
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Oyama
- Department of Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Orozco GA, Smith JH, García JJ. Three-dimensional nonlinear finite element model to estimate backflow during flow-controlled infusions into the brain. Proc Inst Mech Eng H 2020; 234:1018-1028. [DOI: 10.1177/0954411920937220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Convection-enhanced delivery is a technique to bypass the blood–brain barrier and deliver therapeutic drugs into the brain tissue. However, animal investigations and preliminary clinical trials have reported reduced efficacy to transport the infused drug in specific zones, attributed mainly to backflow, in which an annular gap is formed outside the catheter and the fluid preferentially flows toward the surface of the brain rather than through the tissue in front of the cannula tip. In this study, a three-dimensional human brain finite element model of backflow was developed to study the influence of anatomical structures during flow-controlled infusions. Predictions of backflow length were compared under the influence of ventricular pressure and the distance between the cannula and the ventricles. Simulations with zero relative ventricle pressure displayed similar backflow length predictions for larger cannula-ventricle distances. In addition, infusions near the ventricles revealed smaller backflow length and the liquid was observed to escape to the longitudinal fissure and ventricular cavities. Simulations with larger cannula-ventricle distances and nonzero relative ventricular pressure showed an increase of fluid flow through the tissue and away from the ventricles. These results reveal the importance of considering both the subject-specific anatomical details and the nonlinear effects in models focused on analyzing current and potential treatment options associated with convection-enhanced delivery optimization for future clinical trials.
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Affiliation(s)
- Gustavo A Orozco
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Joshua H Smith
- Department of Mechanical Engineering, Lafayette College, Easton, PA, USA
| | - José J García
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia
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11
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Kondo A, Akiyama O, Aoki S, Arai H. Application of intra-operative magnetic resonance imaging for intracranial epidermoid cysts. Br J Neurosurg 2020:1-5. [PMID: 32590920 DOI: 10.1080/02688697.2020.1784844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The effectiveness and safety of intraoperative magnetic resonance imaging (iMRI) are evident from many reports over the past decade. However, these reports have mainly concerned surgeries for glioma and other intra-axial tumours, and applications of this approach for extra-axial tumours are poorly documented. We retrospectively examined three cases in which iMRI was used to assist in the removal of epidermoid cysts. T2-weighted images and diffusion-weighted images were acquired during the surgeries. The value to surgeons of images generated by iMRI, the length of interruption of surgery, and the safety of the patients were assessed. In this study, the images obtained through iMRI provided were clear representations of remnant tumours, even with a low-field system (0.4 Tesla). These images generated enough information to help surgeons decide whether to use an assistance device, such as an endoscope, to remove remnant tumours and whether further retraction of the brain was safe for patients and useful in tumour removal. Intraoperative MRI has long been thought unnecessary for surgery for tumours that are well demarcated and clearly visible under a surgical microscope; in this study, however, intraoperative MRI proved to be useful and safe for patients undergoing epidermoid cyst resection.
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Affiliation(s)
- Akihide Kondo
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Osamu Akiyama
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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12
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Li C, Fan X, Hong J, Roberts DW, Aronson JP, Paulsen KD. Model-Based Image Updating for Brain Shift in Deep Brain Stimulation Electrode Placement Surgery. IEEE Trans Biomed Eng 2020; 67:3542-3552. [PMID: 32340934 DOI: 10.1109/tbme.2020.2990669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The efficacy of deep brain stimulation (DBS) depends on accurate placement of electrodes. Although stereotactic frames enable co-registration of image-based surgical planning and the operative field, the accuracy of electrode placement can be degraded by intra-operative brain shift. In this study, we adapted a biomechanical model to estimate whole brain displacements from which we deformed preoperative CT (preCT) to generate an updated CT (uCT) that compensates for brain shift. METHODS We drove the deformation model using displacement data derived from deformation in the frontal cortical surface that occurred during the DBS intervention. We evaluated 15 patients, retrospectively, who underwent bilateral DBS surgery, and assessed the accuracy of uCT in terms of target registration error (TRE) relative to a CT acquired post-placement (postCT). We further divided subjects into large (Group L) and small (Group S) deformation groups based on a TRE threshold of 1.6mm. Anterior commissure (AC), posterior commissure (PC) and pineal gland (PG) were identified on preCT and postCT and used to quantify TREs in preCT and uCT. RESULTS In the group of large brain deformation, average TREs for uCT were 1.11 ± 0.13 and 1.07 ± 0.38 mm at AC and PC, respectively, compared to 1.85 ± 0.17 and 0.92 ± 0.52 mm for preCT. The model updating approach improved AC localization but did not alter TREs at PC. CONCLUSION This preliminary study suggests that our image updating method may compensate for brain shift around surgical targets of importance during DBS surgery, although further investigation is warranted before conclusive evidence will be available. SIGNIFICANCE With further development and evaluation, our model-based image updating method using intraoperative sparse data may compensate for brain shift in DBS surgery efficiently, and have utility in updating targeting coordinates.
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13
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de Font-Réaulx E, López RL, Díaz López LG. Infrared thermography mapping plus neuronavigation target location in an eloquent area cavernoma resection. Surg Neurol Int 2020; 11:44. [PMID: 32257570 PMCID: PMC7110428 DOI: 10.25259/sni_435_2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Safety and efficacy are irrebuttable goals in neurosurgery. Methods We performed a subcortical cavernoma resection in an eloquent area, where we recorded and compared the maximal and minimal brain temperature measured by an infrared thermographic camera and thermometer with the neuronavigation (NN) target location and real anatomical lesion location. Results The hottest cortical point correlated to the subcortical cavernoma location. The NN located the target at 10 mm away from the hottest point. Conclusion More studies are needed to better understand the thermic radiation of the brain in health and in disease, but we believe that evaluating brain temperature, it could be possible to improve accuracy in neurosurgery and generate more knowledge about brain metabolism in vivo.
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Affiliation(s)
| | - Ramón López López
- Department of Neurosurgery, High Specialty Medical Unit, La Raza Hospital, Mexican Social Security Institute, Mexico City, México
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14
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Fan X, Roberts DW, Olson JD, Ji S, Schaewe TJ, Simon DA, Paulsen KD. Image Updating for Brain Shift Compensation During Resection. Oper Neurosurg (Hagerstown) 2019; 14:402-411. [PMID: 28658934 DOI: 10.1093/ons/opx123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In open-cranial neurosurgery, preoperative magnetic resonance (pMR) images are typically coregistered for intraoperative guidance. Their accuracy can be significantly degraded by intraoperative brain deformation, especially when resection is involved. OBJECTIVE To produce model updated MR (uMR) images to compensate for brain shift that occurred during resection, and evaluate the performance of the image-updating process in terms of accuracy and computational efficiency. METHODS In 14 resection cases, intraoperative stereovision image pairs were acquired after dural opening and during resection to generate displacement maps of the surgical field. These data were assimilated by a biomechanical model to create uMR volumes of the evolving surgical field. A tracked stylus provided independent measurements of feature locations to quantify target registration errors (TREs) in the original coregistered pMR and uMR as surgery progressed. RESULTS Updated MR TREs were 1.66 ± 0.27 and 1.92 ± 0.49 mm in the 14 cases after dural opening and after partial resection, respectively, compared to 8.48 ± 3.74 and 8.77 ± 4.61 mm for pMR, respectively. The overall computational time for generating uMRs after partial resection was less than 10 min. CONCLUSION We have developed an image-updating system to compensate for brain deformation during resection using a computational model with data assimilation of displacements measured with intraoperative stereovision imaging that maintains TREs less than 2 mm on average.
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Affiliation(s)
- Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - David W Roberts
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Su, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan D Olson
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | | | - David A Simon
- Medtronic, PLC, Brain Therapies, Neurosurgery, Louisville, Colorado
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Su, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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15
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Davis SC, Folaron MR, Strawbridge RR, Filan C, Samkoe KS, Roberts DW. On the use of fluorescein-based contrast agents as analogs to MRI-gadolinium agents for imaging brain tumors. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2019; 10862. [PMID: 31929673 DOI: 10.1117/12.2510905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Magnetic resonance imaging (MRI) of gadolinium (Gd)-based contrast agents plays a central role in managing the treatment of intracranial tumors. These images are involved in diagnosis, surgical planning, surgical navigation, and postoperative assessment of extent of resection. Replicating the information from Gd-MRI in the visual surgical field using fluorescent agents that behave similar to gadolinium in vivo would represent a major advance for surgical intervention of these tumors, and could provide robust compensation information to update pre-operative MRI images during surgery. In this paper, we examine the uptake of a Gd-based contrast agent in orthotopic tumor models and compare this behavior to two fluorescein-based contrast agents; specifically, clinical-grade sodium fluorescein (NaFl) and a 900 Da pegylated form of fluorescein. We show that the pegylated form of fluorescein is a more promising Gd-analog candidate.
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Affiliation(s)
- Scott C Davis
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH USA 03755-8001
| | - Margaret R Folaron
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH USA 03755-8001
| | - Rendall R Strawbridge
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH USA 03755-8001
| | - Caroline Filan
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH USA 03755-8001
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, 14 Engineering Dr., Hanover, NH USA 03755-8001.,Department of Surgery, Geisel School of Medicine, 1 Rope Ferry Rd., Hanover, NH USA 03755
| | - David W Roberts
- Department of Surgery, Geisel School of Medicine, 1 Rope Ferry Rd., Hanover, NH USA 03755.,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA 03756
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16
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Presurgical Planning for Supratentorial Lesions with Free Slicer Software and Sina App. World Neurosurg 2017; 106:193-197. [DOI: 10.1016/j.wneu.2017.06.146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/24/2022]
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